By Kristin Scott, director of business development at the Society of Hospital Medicine in Philadelphia.


Even experienced pharma marketers who may have years of developing marketing and communication strategies for hospitals and/or vertically integrated systems might not fully understand and appreciate the critical needs and differentiators of inpatient physicians. With the way this increasingly important channel has quickly evolved, driven by healthcare reform and the value-based reimbursement environment, how can they not only keep up but get out ahead of the needs and solutions this market requires? How will they learn what they need to know to position their products for success? The answer is by listening and partnering.

The purchasing and decision making processes are changing. Decades ago, physicians could prescribe whatever they wanted. When formularies started to impose on the freedom to choose medications, finding a physician and/or pharmacist on the pharmacy and therapeutics (P&T) committee and providing solid efficacy and safety information (and hopefully successful clinical reinforcement with their own patients) could mean the difference between having your product available or not. Once managed care, GPOs (group purchasing organizations), DSHs (disproportionate share hospitals), 340B pricing, and direct contracting infiltrated, purchasers started to influence the P&T process more and pharmaceutical marketers and sales representatives had to also demonstrate economic value and benefits to the story. Still, compared to today, that was the golden age of hospital marketing and sales.

Now, marketers have to go beyond demonstrating product value alone as today’s decision makers are charged with improving population health outcomes, increasing patient satisfaction and achieving meaningful quality improvement. Systems are focusing on total cost of care, readmission rates, length of stay, events 30, 60, or 90 days post-discharge, appropriate use of tests and medications and recording/documentation. Pay-for-performance includes ACOs (accountable care organizations) and bundled payments. Mandatory use of EHRs add more top-down pressure regarding how data is collected and decisions and protocols are made, communicated, and enforced. One way you can listen to the market forces is by bookmarking the website for Hospital and Post-Acute Care settings sections or better yet, subscribe to their email alerts for updates.

Hospitalists, inpatient nurses, clinical pharmacists, discharge planners, and hospital medicine practice administrators play a key role in patient management and treatment decisions. High-level decisions are also made by the chief medical officers and chief quality officers. Some have formed diagnostic management teams that tap the expertise of pathologists and other laboratory medicine specialists to guide clinical decision making. Each of these customers requires a modified solution and to hear a customized message. How can marketers create them and make sure the field forces understand and can deliver them in an efficient and productive way?

One way is better listening. Are you including the many critical inpatient customers in your market research? Do you understand what they want and need? How they work? Do you have a clear understanding of how specialists work with hospitalists and the inpatient team? Are your sales reps targeting all of them? Are you cultivating them as KOLs, speakers, tools and resource development contributors? You must also be listening to another critical customer – your field-based forces.

Most seasoned marketers will admit that the best sources of this kind of information are the customer-facing field-forces that are in these systems every day and can provide extremely valuable insights and suggestions – if marketers make the time and effort to listen. You’ll need to go beyond the traditional hospital sales representative (or primary care) and assign MSLs and health outcomes specialists to build deeper and richer clinical understanding and advocacy for your brand with a wide variety of clinicians that may be difficult to reach. They should be the best staff you can find to put on the front lines.

Account managers are needed to support more of a business to business interaction with C-Suite and D-Suite through programs and services that support the “triple aim.” Your account teams need to work together to make sure their strategies and messages are purposeful and consistent for the system as a whole and the key players within. Assigning the entire system to one person or team will encourage a more strategic approach as many systems are applying quality improvement efforts system-wide so that patients can be admitted to any of the individual facilities and receive the same level of care. There are obvious economies of scale to this approach as well.

To show you are listening, assign a product manager or director to own the hospital and health system (and VA/DoD) markets on behalf of all promoted products and let him or her keep you informed and ahead and help you with your positioning and messaging. Most companies have marketing teams in silos, which is fine for outpatient settings and specialists, but can present problems for representing a company-wide solution and portfolio of products to the hospital/health system customers.

One thing you’ll hear from your hospital sales reps is that access to these inpatient providers gets more and more difficult. HIPPA will not allow reps on inpatient-care areas. Even if it did, the hospitals now have “NO REPS” policies. Most specialists at least have academic offices, outpatient clinics and/or procedures where they can be found. This is not the case with inpatient nurses and hospitalists. If they are your target for growing inpatient (and subsequent outpatient) prescriptions, you’ll need another way.

This is where partnering can help. First, if you use an agency, they should be informing you on a consistent basis of current trends, shifts and policies in the hospital and health system markets, what strategies will be most effective, how to differentiate your brand, and how to get the differentiated and customized messages through. You should hear them speak about value, quality improvement, and total cost of care. If you are not hearing this, maybe you need to hire a separate agency just for your institutional marketing.

Most pharma companies have staff that represents the company and builds relationships and partners with professional medical societies. These people can help the brands, the field sales management teams and others to find access channels they were not using. These folks also inform the medical societies of key initiatives with patients, certain disease states, and reimbursement. Some to consider are Society of Hospital Medicine, Society of Critical Care Medicine, American College of Physicians, Society of General Internal Medicine, and American Society of Hospital and Health System Pharmacists. Do not forget nurse practitioners, physician assistants, and hospital pharmacists. These professional medical societies have the mission to improve the care of the patients their members serve and they are always in need of information, resources and funding to support innovation and improvement.

Another potential source of partnership is with companies that are also in the hospital medicine space targeting the same customers, for example: recruiting and staffing, practice management, coding and billing, scribes, EMR/EHR, Hospitalist Management Companies. Talk to them about what their objectives are and how you might work together to reach the same customers but with different, non-competing messages. Again, your field forces might be ahead of you here.

Finally, evaluating the market potential of hospitals and health systems can be challenging without inpatient physician-based prescription tracking. You might see that the accounts are purchasing drugs in your therapeutic area but can’t specify who is writing them. Feel assured knowing that more than 50 percent of all patients are discharged by hospitalists and 95 percent of U.S. hospitals with more than 200 beds have hospitalists. If your marketing and sales efforts are effective, you should see growth not just in the inpatient prescriptions but into the communities as well.